omeprazole

CLINICAL USE

Gastric acid suppression

DOSE IN NORMAL RENAL FUNCTION

Oral: 10–120 mg daily IV: 40 mg once daily for up to 5 days Patients with recent bleeding on endoscopy: 80 mg stat followed by 8 mg/hour for 72 hours (British Society of Gastroenterology)

PHARMACOKINETICS

Molecular weight :345.4

%Protein binding :95

%Excreted unchanged in urine : Minimal

Volume of distribution (L/kg) :0.3

half-life – normal/ESRD (hrs) :0.5–3/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anticoagulants: effect of coumarins possibly enhanced

Anti-epileptics: effects of phenytoin possibly enhanced

Antivirals: reduced atazanavir concentration – avoid concomitant use; AUC of saquinavir increased by 82% (increased risk of toxicity)

Ciclosporin: variable response; mostly increase in ciclosporin levelCilostazol: increased cilostazol concentration – avoid concomitant use

Tacrolimus: may increase tacrolimus concentration

ADMINISTRATION

Reconstition

5 mL solvent provided per 40 mg vial

Route

Oral, IV

Rate of Administration

Bolus: over 5 minutes Infusion: 40 mg over 20–30 minutes Continuous infusion: 8 mg/hour

Comments

Add to 100 mL sodium chloride 0.9% or glucose 5%Once diluted stable for 12 hours in sodium chloride 0.9% and 3 hours in glucose 5%Use oral as soon as possible 200 mg in 50 mL for 8 mg/hour infusion. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006)

OTHER INFORMATION

Omeprazole clearance is not limited by renal disease.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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